Provider Demographics
NPI:1982891537
Name:WATSON, MARY JANE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY JANE
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 STINSON BLVD NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2615
Mailing Address - Country:US
Mailing Address - Phone:612-676-3464
Mailing Address - Fax:612-884-2143
Practice Address - Street 1:500 STINSON BLVD NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2615
Practice Address - Country:US
Practice Address - Phone:612-676-3464
Practice Address - Fax:612-884-2143
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist